Am I at Risk for Type 2 Diabetes? Taking Steps to Lower Your ...

1.
NatioNal Diabetes iNformatioN CleariNghouse
Am I at
Risk for
Type 2
Diabetes?
Taking Steps to
Lower Your Risk of
Getting Diabetes
U.S. Department
of Health and
Human Services
NATIONAL INSTITUTES OF HEALTH National Diabetes Information Clearinghouse

2.
Am I at Risk for
Type 2 Diabetes?
Taking Steps to Lower Your Risk
of Getting Diabetes
U.S. Department
of Health and
Human Services
NATIONAL INSTITUTES OF HEALTH National Diabetes Information Clearinghouse

4.
Taking Steps to Lower Your Risk of Getting Diabetes
What is type 2 diabetes?
Diabetes is a disease in which blood glucose levels are above
normal . People with diabetes have problems converting food
to energy . After a meal, food is broken down into a sugar
called glucose, which is carried by the blood to cells throughout
the body . Cells use the hormone insulin, made in the pancreas,
to help them process blood glucose into energy .
People develop type 2 diabetes because the cells in the muscles,
liver, and fat do not use insulin properly . Eventually, the
pancreas cannot make enough insulin for the body’s needs .
As a result, the amount of glucose in the blood increases
while the cells are starved of energy . Over the years, high
blood glucose damages nerves and blood vessels, leading to
complications such as heart disease, stroke, blindness, kidney
disease, nerve problems, gum infections, and amputation .
Can type 2 diabetes be prevented?
Research has demonstrated that people at risk for type 2
diabetes can prevent or delay developing type 2 diabetes by
losing a little weight . The results of the Diabetes Prevention
Program (DPP) showed that weight loss
through moderate diet changes and physical
activity can delay and prevent type 2
diabetes . Participants in this federally
funded study of 3,234 people at high risk
for diabetes experienced a 5- to 7-percent
weight loss . For example, a 5- to 7-percent
weight loss for a 200-pound person would be
10 to 14 pounds .
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5.
Am I at Risk for Type 2 Diabetes?
Family history and overweight are strong risk factors for type 2
diabetes . DPP study participants were overweight and had
higher than normal levels of blood glucose, a condition called
pre-diabetes, also called impaired glucose tolerance . Both pre­
diabetes and obesity are strong risk factors for type 2 diabetes .
Because of the high risk for diabetes among some minority
groups, about half of the DPP participants were African
American, Alaska Native, American Indian, Asian American,
Pacific Islander, or Hispanic/Latino .
DPP participants also included others at high risk for
developing type 2 diabetes, such as women with a history of
gestational diabetes and individuals aged 60 and older .
The DPP tested two approaches to preventing diabetes:
lifestyle change—a program of healthy eating and physical
activity—and the diabetes drug metformin . People in the
lifestyle change group exercised about 30 minutes a day 5 days
a week, usually by walking, and lowered their intake of fat and
calories . Those who took the diabetes drug metformin received
information on physical activity and diet . A third group only
received information on physical activity and diet .
The results showed that people in the lifestyle
change group reduced their risk of getting type 2
diabetes by 58 percent . In the first year of the
study, people lost an average of 15 pounds .
Lifestyle change was even more effective
in those aged 60 and older . They reduced their
risk by 71 percent . People receiving metformin
reduced their risk by 31 percent .
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6.
Taking Steps to Lower Your Risk of Getting Diabetes
Types of Diabetes
The three main kinds of diabetes are type 1, type 2, and
gestational diabetes .
Type 1 Diabetes
Type 1 diabetes, formerly called juvenile diabetes or insulin-
dependent diabetes, is usually first diagnosed in children,
teenagers, or young adults . In this form of diabetes, the
beta cells of the pancreas no longer make insulin because
the body’s immune system has attacked and destroyed them .
Treatment for type 1 diabetes includes taking insulin shots or
using an insulin pump, making wise food choices, exercising
regularly, controlling blood pressure and cholesterol, and
taking aspirin daily—for some .
Type 2 Diabetes
Type 2 diabetes, formerly called adult-onset or noninsulin­
dependent diabetes, is the most common form of diabetes .
People can develop type 2 diabetes at any age, even during
childhood . This form of diabetes usually begins with insulin
resistance, a condition in which fat, muscle, and liver cells
do not use insulin properly . At first, the pancreas keeps
up with the added demand by producing more insulin . In
time, however, it loses the ability to secrete enough insulin in
response to meals . People who are overweight and inactive
are more likely to develop type 2 diabetes . Treatment
includes taking diabetes medicines, making wise food
choices, exercising regularly, controlling blood pressure
and cholesterol, and taking aspirin daily—for some .
Gestational Diabetes
Some women develop gestational diabetes late in pregnancy .
Although this form of diabetes usually goes away after
the baby is born, a woman who has had gestational
diabetes is more likely to develop type 2 diabetes later in
life . Gestational diabetes is caused by the hormones of
pregnancy or a shortage of insulin .
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7.
Am I at Risk for Type 2 Diabetes?
What are the signs and symptoms of
type 2 diabetes?
Nearly 6 million people in the United States have type 2
diabetes and do not know it . Many have no signs or symptoms .
Symptoms can also be so mild that you might not even notice
them . Some people have symptoms but do not suspect diabetes .
Symptoms include
• increased thirst
• increased hunger
• fatigue
• increased urination, especially at night
• weight loss
• blurred vision
• sores that do not heal
Many people do not find out they have the disease until they
have diabetes complications, such as blurry vision or heart
trouble . If you find out early that you have diabetes, then you
can get treatment to prevent damage to your body .
Should I be tested for diabetes?
Anyone 45 years old or older should consider getting tested
for diabetes . If you are 45 or older and overweight—see the
BMI chart on pages 10 and 11—getting tested is strongly
recommended . If you are younger than 45, overweight, and
have one or more of the risk factors on page 5, you should
consider getting tested . Ask your doctor for a fasting blood
glucose test or an oral glucose tolerance test . Your doctor
will tell you if you have normal blood glucose, pre-diabetes, or
diabetes .
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8.
Taking Steps to Lower Your Risk of Getting Diabetes
What does having pre-diabetes mean?
Pre-diabetes means your blood glucose is higher than normal
but lower than the diabetes range . In 2007, at least 57 million
American adults had pre-diabetes . Having pre-diabetes also
means you are at risk for getting type 2 diabetes and heart
disease . However, you can reduce the risk of getting diabetes
and even return to normal blood glucose levels with modest
weight loss through healthy eating and moderate physical
activity . If you are told you have pre-diabetes, have your blood
glucose checked again in 1 to 2 years .
Besides being older and overweight, what other
factors increase my risk for type 2 diabetes?
To find out your risk for type 2 diabetes, check each item that
applies to you .
q I have a parent, brother, or sister with diabetes .
q My family background is Alaska Native, American Indian,
African American, Hispanic/Latino, Asian American,
or Pacific Islander .
q I have had gestational diabetes, or I gave birth to at least
one baby weighing more than 9 pounds .
q My blood pressure is 140/90 mm Hg or above, or I have
been told that I have high blood pressure .
q My cholesterol levels are not normal . My HDL
cholesterol—“good” cholesterol—is below 35 mg/dL, or my
triglyceride level is above 250 mg/dL .
q I am fairly inactive . I exercise fewer than three times
a week .
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9.
Am I at Risk for Type 2 Diabetes?
q I have polycystic ovary syndrome, also called PCOS—
women only .
q On previous testing, I had impaired fasting glucose (IFG)
or impaired glucose tolerance (IGT) .
q I have other clinical conditions associated with insulin
resistance, such as a condition called acanthosis nigricans,
characterized by a dark, velvety rash around my neck or
armpits .
q I have a history of cardiovascular disease .
The more items you checked, the higher your risk .
How can I reduce my risk?
You can do a lot to lower your chances of getting diabetes .
Exercising regularly, reducing fat and calorie intake, and losing
a little weight can help you reduce your risk of developing
type 2 diabetes . Lowering blood pressure and cholesterol
levels also helps you stay healthy .
If you are overweight
Then take these steps:
• Reach and maintain a reasonable body weight (see page 8).
• Make wise food choices most of the time (see page 9).
• Be physically active every day (see page 12).
If you are fairly inactive
Then take this step:
• Be physically active every day (see page 12).
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10.
Taking Steps to Lower Your Risk of Getting Diabetes
If your blood pressure is too high
Then take these steps:
• Reach and maintain a reasonable body weight (see page 8).
• Make wise food choices most of the time (see page 9).
• Reduce your intake of sodium and alcohol (see page 9).
• Be physically active every day (see page 12).
• Talk with your doctor about whether you need medicine to
control your blood pressure (see page 12) .
If your cholesterol or triglyceride levels are too high
Then take these steps:
• Make wise food choices most of the time (see page 9).
• Be physically active every day (see page 12).
• Talk with your doctor about whether you need medicine to
control your cholesterol levels (see page 12) .
Making Changes to Lower My Risk
Making big changes in your life is hard, especially if you are faced
with more than one change . You can make it easier by taking
these steps:
• Make a plan to change behavior.
• Decide exactly what you will do and when you will do it.
• Plan what you need to get ready.
• Think about what might prevent you from reaching your goals.
• Find family and friends who will support and encourage you.
• Decide how you will reward yourself when you do what you
have planned .
Your doctor, a dietitian, or a counselor can help you make a plan .
Consider making changes to lower your risk of diabetes .
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11.
Am I at Risk for Type 2 Diabetes?
Reach and Maintain a Reasonable Body Weight
Your weight affects your health in many ways . Being
overweight can keep your body from making and using insulin
properly . Excess body weight can also cause high blood
pressure .
Body mass index (BMI) is a measure of body weight relative to
height . You can use BMI to see whether you are underweight,
normal weight, overweight, or obese . Use the table on pages
10 and 11 to find your BMI .
• Find your height in the left-hand column.
• Move across in the same row to the number closest to your
weight .
• The number at the top of that column is your BMI. Check
the word above your BMI to see whether you are normal
weight, overweight, or obese .
If you are overweight or obese, choose sensible ways to get in
shape .
• Avoid crash diets. Instead, eat less of the foods you usually
have . Limit the amount of fat you eat .
• Increase your physical activity. Aim for at least 30 minutes
of exercise most days of the week . (See page 12 for
suggestions .)
• Set a reasonable weight-loss goal, such as losing 1 pound a
week . Aim for a long-term goal of losing 5 to 7 percent of
your total body weight .
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12.
Taking Steps to Lower Your Risk of Getting Diabetes
Make Wise Food Choices Most of the Time
What you eat has a big impact on your health . By making wise
food choices, you can help control your body weight, blood
pressure, and cholesterol .
• Take a look at the serving sizes of the foods you eat.
Reduce serving sizes of main courses such as meat,
desserts, and foods high in fat . Increase the amount of
fruits and vegetables .
• Limit your fat intake to about 25 percent of your total
calories . For example, if your food choices add up
to about 2,000 calories a day, try to eat no more than
56 grams of fat . Your doctor or a dietitian can help you
figure out how much fat to have . You can also check food
labels for fat content .
• Limit your sodium intake to less than 2,300 mg—about
1 teaspoon of salt—each day .
• Talk with your doctor about whether you may drink
alcoholic beverages . If you choose to drink alcoholic
beverages, limit your intake to one drink—for women—
or two drinks—for men—per day .
• You may also wish to reduce the number of calories you
have each day . People in the DPP lifestyle change group
lowered their daily calorie total by an average of about 450
calories . Your doctor or dietitian can help you with a meal
plan that emphasizes weight loss .
• Keep a food and exercise log. Write down what you eat,
how much you exercise—anything that helps keep you
on track .
• When you meet your goal, reward yourself with a nonfood
item or activity, like watching a movie .
Continued on Page 12
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Am I at Risk for Type 2 Diabetes?
Be Physically Active Every Day
Regular exercise tackles several risk factors at once . It helps
you lose weight, keeps your cholesterol and blood pressure
under control, and helps your body use insulin . People in
the DPP who were physically active for 30 minutes a day,
5 days a week, reduced their risk of type 2 diabetes . Many
chose brisk walking for exercise .
If you are not very active, you should start slowly . Talk with
your doctor first about what kinds of exercise would be safe
for you . Make a plan to increase your activity level toward the
goal of being active at least 30 minutes a day most days of the
week .
Choose activities you enjoy . Some ways to work extra activity
into your daily routine include the following:
• Take the stairs rather than an elevator or escalator.
• Park at the far end of the parking lot and walk.
• Get off the bus a few stops early and walk the rest of
the way .
• Walk or bicycle whenever you can.
Take Your Prescribed Medications
Some people need medication to help control their blood
pressure or cholesterol levels . If you do, take your medicines
as directed . Ask your doctor about medicines to prevent
type 2 diabetes .
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15.
Taking Steps to Lower Your Risk of Getting Diabetes
Hope through Research
We now know that many people can prevent type 2 diabetes
through weight loss, regular exercise, and lowering their intake
of fat and calories . Researchers are intensively studying
the genetic and environmental factors that underlie the
susceptibility to obesity, pre-diabetes, and diabetes . As they
learn more about the molecular events that lead to diabetes,
they will develop ways to prevent and cure the different stages
of this disease . DPP researchers continue to monitor DPP
participants to learn more about the study’s long-term effects
through the Diabetes Prevention Program Outcomes Study .
People with diabetes and those at risk for it now have easier
access to clinical trials that test promising new approaches to
treatment and prevention . Participants in clinical trials can
play a more active role in their own health care, gain access
to new research treatments before they are widely available,
and help others by contributing to medical research . For
information about current studies, visit www.ClinicalTrials.gov .
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17.
National Diabetes Information Clearinghouse
1 Information Way
Bethesda, MD 20892–3560
Phone: 1–800–860–8747
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: ndic@info .niddk .nih .gov
Internet: www .diabetes .niddk .nih .gov
The National Diabetes Information Clearinghouse (NDIC) is a
service of the National Institute of Diabetes and Digestive and
Kidney Diseases (NIDDK). The NIDDK is part of the National
Institutes of Health of the U .S . Department of Health and
Human Services . Established in 1978, the Clearinghouse provides
information about diabetes to people with diabetes and to their
families, health care professionals, and the public . The NDIC
answers inquiries, develops and distributes publications, and works
closely with professional and patient organizations and Government
agencies to coordinate resources about diabetes .
Publications produced by the Clearinghouse are carefully reviewed
by both NIDDK scientists and outside experts. This booklet was
originally reviewed by David G . Marrero, Ph .D ., Indiana University
School of Medicine, Diabetes Research and Training Center,
and Michael L . Parchman, M .D ., M .P .H ., Associate Professor,
Department of Family and Community Medicine, University of
Texas Health Science Center .
This publication is not copyrighted . The Clearinghouse
encourages users of this booklet to duplicate and distribute as
many copies as desired .
This booklet is also available at www.diabetes.niddk.nih.gov.
This publication may contain information about medications .
When prepared, this publication included the most current
information available . For updates or for questions about any
medications, contact the U .S . Food and Drug Administration
toll-free at 1–888–INFO–FDA (463–6332) or visit www.fda.gov .
Consult your doctor for more information .